Georgia-based medical groups can effectively manage denial claims by identifying the root causes, prioritizing high-impact areas, and improving processes. They should analyze denial data to determine where errors most commonly occur, such as registration, eligibility verification, authorization, and claims submission. Groups can reduce denials by 10% by enhancing registration accuracy, eligibility verification training, pre-authorization checks, and customizing claims edits to payer requirements. Outsourcing denial management to experts can not only provide insights but implement tools and services to eliminate future denials.

1. Georgia Based
Medical Groups Can
Handle
Denial management

2. Georgia Based Medical Groups Can Handle
Denial management Effectively, here’s how?
Claims denials create a heavy issue for hospitals amid
already difficult payment scenarios. Denials are a huge
burden and an enormous obstacle to timely and
complete payment, In 2019, Georgia-based medical
groups managed an astonishing $1 billion in
transactions with a worth of quite $3 trillion. leverage
this data and reports, analysts determined about 9% of
claims worth $262 billion were denied.
These denials compacted 3.3% of overall patient
revenue, translating to a median of $4.9 million per
hospital. This is the sole reason why Georgia-based
medical groups should focus their strategies on
managing denials.

3. Denials aren’t solely extremely prevailing within the healthcare industry, however conjointly
terribly expensive to perform reconsideration and appeals. whereas sixty-three percent of denied
claims were redeemable and can be resolved on 1st reconsideration or appeal, further labor and
workforce related to the reconsideration and appealing method equal a median of $118 per claim
or $8.6 billion overall for U.S. hospitals. Even though denials happen across the complete revenue
cycle, an oversized proportion of volume is related to front-end processes like registration,
authorization, and eligibility errors that create these kinds of denials.
A survey conducted by BillingParadise shares several methods, Georgia-based medical groups
will use to eradicate denials and provides insights on How Georgia-based medical groups can
manage denials:
Hospital leaders should first identify why they are having denials, according to recommended
techniques using available data to analyze revenue cycle management processes to see where
denials are occurring, paying special attention to the following

4. 1. Identifying the Root cause and determining the nature of denials:
Georgia medical group leaders ought to establish why they’re having denials and the data suggested in-depth knowledge
to research revenue cycle management processes to ascertain wherever denials trends occur very often, paying special
attention to the following:
Patient access and registration
Insufficient documentation
Coding and charge errors
Payer behavior
Utilization/case management
When Georgia medical groups are attempting to seem for the root cause, key questions to pose by the RCM department are:
“Is this data readily available?”
“Is it accessible in a very timely manner?”
“Can we trust it in the decision-making?”

5. 2. Categorization and Prioritization:
Once Georgia medical group leaders establish wherever claim denial issues are occurring, they must range areas that may have
the best impact on their medical group’s bottom line. They should drill down the matter to a selected insurance/payer,
department or medical practitioner, or service line and perceive the dollar amount impact of inefficient processes or errors in
these areas adding that a number of the high-priority denial problems could need a method plan.
3. Registration information and data quality:
Hospitals ought to conjointly implement business rules for examining registration information and data to make sure it’s correct,
complete, and consistent. It is wise to have a denial alert system to spot potential denial data quality problems and establish
workflows to correct errors in real time.
This increases its registration accuracy from 90-99% in a few years. Recording in report cards to allow RCM staff members
feedback on their registration accuracy. Also giving them that information and observation however well they are doing to get
specific accuracy on their registrations.

6. 4. Eligibility:
Registration and eligibility account for 23.9% of all denials within the state of Georgia and non-covered services claims for 10.1%,
Georgia medical groups ought to systematically check eligibility throughout the complete patient care or treatment process, from the
time ofappointment scheduling and till the claim submission process is done.
If the procedure isn’t eligible or non-covered, medical groups should have a method to tell patients of their expenses and out-of-
pocket financial responsibility and alternative payment choices such as payment plans, etc.
Some of the Georgia-based medical groups improved their eligibility verification method by revamping RCM staff training. A few
years ago the medical groups conducted point-of-service payment and collection training, in conjunction with insurance and
preregistration training for all preregistration, registration, and admitting RCM staff. These Georgia medical groups needed their RCM
staff to be ready to answer tougher questions on insurance and benefits verifications. By boosting RCM staff training and utilizing
analytics to trace verification levels, these medical groups will execute successful eligibility verifications between 25,000 and 30,000
verifications per month. Hence these Georgia-based medical groups reduced denials by 10% at intervals during the primary three
months following the project.

7. 5. Pre-certification or Prior-Authorization and medical necessity:
Authorization and precertification problems account for 18.2% of denials within the state of Georgia. As a result of these
problems accounting for such a high quantity of denials, medical groups should check that they perceive the important
reason claims were denied for authorization. These medical groups should pose these questions as to “Was it obtained?
Expired? Filed for the incorrect procedure?” Additionally, the medical groups want applicable medical necessity rules to
be raised to inform the charge method and clear any authorization mistakes.
It is thus necessary to create certain aspects whether you are obtaining authorization up front when receiving the
insurance’s approval, the hospital should proactively establish changes with a scheduled procedure or the insurance
setup that would cause a claim denial. The staff should check authorization a number of days before the procedure and
on the day of service. The hospital conjointly depends on the authorization team to verify payers’ authorization
necessities, check the accuracy of authorizations from attached medical practitioner teams, and record calls or
electronically capture proof of authorizations for the hospital’s records.

8. 6. Effective claims process:
Hospitals ought to review claims each midcycle and before the claim is filed to the insurance to see for errors and create
applicable edits. These edits ought to be terribly customizable to the insurance company since every insurance has completely
different necessities and format preferences for claim forms. Oftentimes, a revenue cycle service supplier will work with hospitals
to create these custom edits and author new rules supported by learned money handler behavior. This partner ought to
conjointly update money handler rules often and before the effective date.
It is not only providing actionable information for claim denials that can reduce it, but the implementation of these methods
does. BillingParadise and our team of denial management experts can do more than implement, they can actually put a stop to
all future denials by using innovative denial management tools along with 24/7 denial management services.
To know more about our denial management services and how Georgia-based medical groups can manage denials please
schedule a free consultation with our denial management experts!

9. CONTACT US
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www.billingparadise.com
info@billingparadise.com